What Causes Gynecomastia in Teenagers and Boys?

Gynecomastia in adolescents or teenage boys occurs during puberty, although symptoms can start as early as age 10. However, on average, initial symptoms of gynecomastia start around age 13 to 14. The appearance of man boobs (or moobs) can be extremely distressing and affect confidence and social interaction. Often, gynecomastia symptoms in teenagers will result in avoiding activities that involve showing their chest, such as swimming. Changing clothes at school or college for sports can also be difficult.

By age 17, gynecomastia symptoms will normally have resolved. For teenagers with persistent gynecomastia, treatment or surgery may be required. Before considering any type of gynecomastia treatment, it is vital to visit a doctor for a gynecomastia physical evaluation. Teenagers may then be referred to a specialist in hormone-related conditions and disorders, called an endocrinologist. Various diagnostic blood tests to determine the cause of gynecomastia symptoms are usually carried out. When there are elevated rates of estrogen levels, treatment with medication may be an option. Three types of medication may be recommended to treat gynecomastia in teenagers caused by a hormone imbalance. 

Gynecomastia Symptoms in Teenagers and Boys

The initial symptoms of gynecomastia in teenagers and boys can vary. Usually, they will consist of slight soreness or tenderness in the chest area, increased nipple sensation, and a small lump underneath either one or both nipples. Increased growth of breast tissue may also occur, resulting in a more feminine appearance of the chest area. Gynecomastia has been classified into four grades, with grade 1 being the least severe and grade 4 the most severe. 

What Is Hormonal Gynecomastia in Teenagers?

Estrogen and androgen receptors determine the degree that breast glandular tissue grows in boys. Estrogen is responsible for breast tissue growth, and androgen receptors in boys are responsible for inhibiting the formation of excess glandular tissue. Gynecomastia symptoms in boys are thought to result from a rise in estrogen and an imbalance between estrogen levels and androgen receptors. 

During puberty, this causes the appearance of male breasts or man boobs. By the age of around 17, the balance corrects itself, and gynecomastia symptoms regress. This is why treatment with medication for gynecomastia in boys and younger teenagers is not usually offered. Psychological therapy is normally considered a more appropriate way of helping boys and teenagers affected by gynecomastia symptoms. 

By age 18, if gynecomastia symptoms persist, various medications have been shown to cause a regression of gynecomastia symptoms. The success of medications varies, and research has shown differing results in regression of gynecomastia symptoms following treatment with “gynecomastia” medication. 

Medication for the Treatment of Gynecomastia Symptoms in Teenagers

Currently, medication for gynecomastia is not FDA approved. The medications have been FDA approved for the treatment of other conditions, and when used for gynecomastia treatment, this is called “off-label” use. However, when a hormonal imbalance is diagnosed following blood tests, medications are often the first step for teenagers with persistent gynecomastia symptoms. There are three categories of medication that treat the estrogen/androgen imbalance, and they work in different ways.

Medications for Gynecomastia to Block Estrogen Receptors 

Medications designed to block estrogen receptors are collectively called selective estrogen receptor modulators  (SERMS). This type of medication is usually used to treat painful gynecomastia symptoms. The body continues to produce estrogen, but the effect on the breast cells is blocked. This category of medication was initially used to treat or reduce the risk of breast cancer in females.

The four SERMS for gynecomastia symptoms are:

  1. Tamoxifen (Brand name: Soltamox and Nolvadex) 
  2. Raloxifene (Brand name: Evista)
  3. Clomiphene (Brand name: Clomid )
  4. Toremifene (Brand name: Fareston).

Other medications used to treat gynecomastia symptoms include:

  • Danzole (Brand name: Danocrine) a synthetic androgen similar to testosterone.
  • Anastrozole (Brand name: Arimidex) a type of estrogen inhibitor that works by stopping the production of estrogen. 

Gynecomastia Medications Side Effects

All gynecomastia medications come with associated side effects, which are often the reason for discontinuing use. Research has shown that in some cases, when gynecomastia medication is stopped, gynecomastia symptoms can return.

Gynecomastia medication side effects include:

  • Erectile dysfunction 
  • Testicular atrophy (reduction in size of the testicles)
  • Sperm count decline
  • Reduction in bone density
  • Joint pain
  • Nausea and vomiting
  • Nipple tenderness
  • Visual disturbances 
  • Hair loss
  • Weight gain
  • Fatigue
  • Hot flushes
  • Headaches
  • Skin rash and irritation.

Gynecomastia Surgery for Teenagers and Adolescents 

Gynecomastia surgery is considered the most reliable solution to get rid of gynecomastia symptoms. It is the only permanent treatment for gynecomastia symptoms that does not come with the side effects that can be caused by gynecomastia medication. These side effects are one of the main reasons many male adolescents decide to have gynecomastia surgery. 

When choosing whether to try gynecomastia medication, it is important to consider how the side effect may impact you psychologically. This is especially relevant for teenage boys who already have psychological difficulties due to their gynecomastia symptoms. Gynecomastia surgery also has associated risks and complications, although they are rare or normally easily rectified with appropriate treatment. When gynecomastia surgery is performed by an experienced plastic surgeon, the patient satisfaction rate is high and incidence of complications relatively low.

Types of Gynecomastia Surgery  

Various procedures can correct gynecomastia symptoms and get rid of man boobs for good. The procedure option will be determined by the gynecomastia symptoms, and severe gynecomastia symptoms will require more extensive surgery to remove excess skin. When considering gynecomastia surgery, one of the main concerns is scars. 

Grade 1 and 2 gynecomastia incisions are normally located around the bottom edge of the areola. The resulting scars are usually difficult to detect due to the difference in color between the areola and the surrounding chest skin. Scars continue to fade and normally become difficult to detect within six months to a year. 

Gynecomastia Surgery for Grade 1 and Grade 2 Gynecomastia 

The “Pull Through” technique is a relatively new technique developed to treat grade 1 and some grade 2 cases of gynecomastia symptoms. The advantage with this technique is the absence of visible scars due to the small incision required. Liposuction may also be needed to even out the contours of the chest. The disadvantage is that this technique can often produce uneven results when not performed correctly. This is one of the reasons gynecomastia revision surgery is generally requested following this procedure.  

The “Standard” technique is usually used for grade 2 gynecomastia cases and involves a slightly longer incision around the bottom half of the areola. The breast glands are then excised along with fatty tissue, and liposuction is also often performed to smooth out the chest contours. The patient satisfaction rate following this procedure is high, and the scars, when healed, tend to be hard to see unless looking very closely.

A two-stage procedure is sometimes required for grade 2 and may be recommended for grade 3 gynecomastia symptoms. The first stage is the standard technique, followed by a periareolar lift around four to six months later. The periareolar lift is performed to remove excess skin and improve the contour of the chest. The advantage of the two-stage procedure is that incisions are only made around the edge of the areola.

Gynecomastia Surgery for Grade 3 and 4 Gynecomastia 

Grade 3 and 4 gynecomastia symptoms are rare in teenagers. When they do occur, incisions in the breast crease are required to remove excess skin. In some cases, the skin crease will extend to a roll that will continue to the back. When this happens, the incisions will need to be extended, and the resulting scars will inevitably be longer and more noticeable.

A double incision mastectomy is the most effective gynecomastia surgery for most grade 3 and all grade 4 gynecomastia symptoms. The procedure involves an incision made in the breast crease, which may extend to the back. The breast glandular and fatty tissue is excised, and liposuction is performed for even contours. Although scars will be visible, once faded, they tend not to be an issue, and most patients report being very happy with the results of this procedure. 

 

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Dr. Delgado is a world-renowned Board-Certified Plastic Surgeon, a member of the American Society of Plastic Surgeons, and a recognized expert in the field of gynecomastia surgical procedures. Dr. Delgado is the medical director of Gynecomastia.org — the largest international forum providing unprecedented resources about gynecomastia treatments and surgical options.